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    Infertility During COVID-19

    Carrye Daum, MD Women's Health Care P.C. 04/22/2020
    Infertility in the Time of COVID-19, National Infertility Awareness Week

    With elective medical procedures on hold in recent weeks, fertility treatments have been halted across much of the US.  The American Society for Reproductive Medicine published recommendations in March to delay new treatment cycles – ovulation induction, intrauterine insemination (IUI), and IVF procedures including egg retrievals and embryo transfers.  

    As an OBGYN physician, I have taken care of patients with infertility in various contexts since my residency training – making the initial diagnosis, initiating the work-up, referring to REI specialists, and the most gratifying aspect, which is delivering the babies of these patients.  

    It wasn’t until I became an infertility patient myself that I fully understood the overwhelming stress that comes with it.  Take it from me that we can be some of the most impatient patients out there – and rightfully so!  We have already spent countless months trying to conceive before even earning the diagnosis of infertility, and once we are finally presented with some possible solutions, they can’t happen fast enough.  

    As infertility patients, we spend our months and years waiting – waiting for a period, waiting on our work-up to be completed, waiting on pregnancy test results, waiting for a treatment to be successful, waiting to initiate the next steps when a certain treatment doesn’t work.  Our biological clocks have been ticking at a deafening volume.  Every month that passes without becoming pregnant feels like a missed opportunity, which adds to the stress of the entire process. 

    My fertility story began when I got married during my OB/GYN residency.  I am the oldest of five sisters, and my husband is the youngest of five siblings, as well.  We dreamed of having several kids – maybe even five – if we could.  Getting married at age 29 and wanting five kids meant that we probably needed to get started.  

    However, I suspected that becoming pregnant might be a challenge due to my polycystic ovarian syndrome (PCOS), which is a hormonal issue that affects ovulation.  For most women with regular cycles, the chance of becoming pregnant during any given month is approximately 20% (assuming no other issues).  With a 20% chance every month, after several consecutive months of trying, most couples are pregnant.  For PCOS patients, this percentage can be much lower.  Some patients with PCOS rarely ovulate or have cycles at all.  You can’t predict ovulation if there is no cycle.  We typically don’t get 12 chances per year like most people.  

    I spent several months taking weekly pregnancy tests just to see if they would ever become positive.  I joke now that the one time I ever ovulated on my own, we were successful.  I couldn’t believe my eyes – a test was actually positive, and we had our son Carter later that year.  Two years later, we wanted to try again.  This time, it required fertility medication to assist with ovulation.  This particular medication can help bring a patient’s chance of success per month closer to 15% – nearing the baseline for most other women.  We were lucky that the medication was successful fairly quickly, and we had our son Hudson.

    In 2019, we felt like our family plan was right on schedule.  We wanted to try again, so we restarted fertility medication at the beginning of the year.  I was expecting a result similar to my second pregnancy – try the medication for a month or two, maybe three, and hopefully deliver by the end of the year.  With a ~15% chance per month, it felt like gambling – keep going and one of these attempts, it’s going to work out. It’s got to work. It has worked before.  

    However, months went by…seasons went by...I turned another year older.  Tests were negative.  It didn’t work. 

    I was going to be a bridesmaid for one of my best friends in August, so I had purchased an oversized dress in order to accommodate the growing pregnant belly I thought I would have by then.  Wishful thinking.  The joke was on me when I was very NOT pregnant in August and took it to have it tailored to my normal size.

    I went for a consultation with our infertility specialist and explored my remaining options.  By late 2019, my husband and I decided to proceed with IVF.  I had taken care of many IVF patients for their pregnancy care, but it turns out that I had no idea what these patients actually went through.  

    Let me preface my IVF experience by letting you know that I am a person who has been terrified of needles my entire life.  My mom had to carry me out of the mall at age 15 after getting my ears pierced.  I fainted when I got my shots for medical school. I can point a needle at you, but when it is pointed at me, it’s over.  I had to get over that REAL QUICK once the IVF process started. I spent months giving myself between 1 to 3 injections per day once it was all said and done.  

    Another thing I did not realize prior to experiencing it myself is that egg retrieval is NO JOKE.  Essentially, you take medications to significantly enlarge your ovaries, then a procedure is performed under sedation to collect as many eggs as possible.  The day before my egg retrieval, my abdomen felt like a balloon on the verge of popping.  To put things in perspective, every month when a woman ovulates, she gets a ~2 cm (or nearly 1-inch) follicle on one of her ovaries.  I had nearly 30 follicles present between my two ovaries – they were huge!  

    The morning of the egg retrieval, I asked my doctor if I would have relief after the procedure, since I felt like a balloon and was under the impression that the follicles were going to be deflated with the retrieval.  I really needed to make it to Evansville’s “Fall Festival” that night – if you’ve ever been, you understand why.  He let me know that the follicles would likely reaccumulate their fluid, and I would probably be sore for a few days.  

    Flash forward 8 hours – woo, child! I was hobbling around the Fall Festival like the Tin Man in the Wizard of Oz, trying to find my dumplings, pronto pup, and funnel cake.  Egg retrieval is NO 👏 JOKE! 👏  I truly had no idea until I went through it myself. 

    After a few more weeks, our IVF process was complete.  We were so fortunate to receive the news that it worked.  Although I did not get pregnant the way I thought or with the timing we had planned, we were successfully pregnant again.  Going through the process myself gave me so much appreciation for my IVF patients and both the physical and emotional stress that they experience throughout the process.  It’s a rollercoaster – full of ups, downs, and lots of waiting.  

    Everyone’s fertility journey is different.  I struggled to become pregnant with my third child, and I know that I am fortunate that the process worked.  I realize that many patients struggle to conceive their first child and have a much longer, rockier road than we have had to traverse.  I know that I am lucky to have the kids that I do, and I know that my story pales in comparison to many.  PCOS is only one potential cause of fertility issues, and the answer is not always as clear for many couples. 

    We were lucky that our process went so smoothly and that it was finished before COVID-19 was an issue.  It’s hard to imagine being in the middle of my infertility work-up and having it halted for an indefinite amount of time due to the pandemic.  

    With National Infertility Awareness Week upon us, this year it is especially important to remember the patients whose treatments are on hold.  The ticking of the clock has never been louder, especially when the end of this COVID-19 ordeal is uncertain.  While some people are worried about when they’ll get to go bowling or get a pedicure again, there are others who are worried about whether they will become a parent.  We are all anxious to get back to our normal routines, but please recognize that some people are experiencing a huge interruption in the planning of their families.  Please keep these patients in your thoughts during this time.   

    #NIAW #NationalInfertilityAwarenessWeek
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